Extracorporeal surgery on kidneys and renal vessels is an unfamiliar field of surgery for the medical community. This surgical approach involves performing surgery on an organ outside the body or, in other words, ex vivo. However, such interventions have several undeniable advantages in special clinical situations. These include: kidney ischemia, better visualization, work in a bloodless area and almost unlimited time, safe for kidney function. However, despite all the advantages of this surgical approach, it is not widely used in everyday clinical practice due to the technical complexity of the surgery. As a result of the analysis of the available literature, it is clear that these surgeries can be effective in a wide range of diseases. The problem of radical surgical treatment is especially acute when the standard approach is not possible, when the operation is performed in situ. In such cases, the performance of extracorporeal surgery with subsequent kidney autotransplantation allows to perform radical treatment in case of particularly pronounced damage to the kidney and/or its vessels. A review of literature is given, which presents the history of formation and development of extracorporeal surgeries on kidneys and renal vessels. Experimental extracorporeal interventions with kidney autotransplantation and clinical observations are chronologically described in the article. Literal data on the performance of extracorporeal surgeries in a wide range of different diseases are summarized. The domestic and foreign experience of such interventions is reflected as widely as possible. The stages of development of extracorporeal renal surgery from the first clinical observations to the present day are described. The distant results of the largest researches indicating appropriateness, expediency and validity of performance of similar surgeries are given. Particular relevance of this surgical technique is acquired when the standard, intracorporeal intervention is unavailable. Thus, the use of extracorporeal surgery technique allows to expand the possibilities of providing surgical assistance to patients with various pathologies of the kidneys and/or renal vessels.

AIM . Within the framework of outpatient and hospital registers of REGION (REGIster of patients who have undergone acute cerebrovascular accident) to carry out a comparative assessment of demographic and clinical-anamnestical characteristics, medical treatment and outcomes in clinical practice in patients with a combination of undergone acute cerebrovascular accident (ACVA) and atrial fibrillation (AF) in the presence or absence of myocardial infarction (MI) in the medical history. MATERIAL AND METHODS . Outpatient registers REGION (Ryazan) and hospital register REGION (Moscow) included 1886 patients who have undergone ACVA (age 70.6 ± 12.5 years, 41.9% of men), of them 516 (27.4%) people with AF. Comparison groups included 152 (8.1%) patients with a combination of ACVA, AF and MI in medical history (ACVA + AF + MI group) and 364 (19.3%) patients with ACVA, AF without MI (ACVA + AF without MI group). The presence of cardiovascular diseases (CVD), concomitant diseases, drug therapy and outcomes were analyzed. RESULTS. In the group of ACVA + AF + MI patients, compared to the ACVA + AF without MI group, the share of patients with AH (100% and 97.2%), IHD (100% and 87.1%), CHD (68.4% and 57.1%), repeated ACVA (36.9% and 23.9%), diabetes mellitus in women (39.5% and 20.4%) was statistically significantly higher. In the comparison groups, the share of smokers (13.3% and 15.5%), patients with burdened heredity of early development of CVDs (2.1% and 1.1%) and hypercholesterolemia (41.1% and 50.0%) did not differ significantly, however, in the group of ACVA + AF + MI, in comparison with the group of ACVA + AF without MI, there was a higher risk on the CHA2DS2-VASc scale (5.26 ± 1.32 and 4.09 ± 1.44; p < 0.001) and HAS-BLED scale (1.91 ± 0.76 and 1.62 ± 0.79; p < 0.01). Patients with AF of REGION register, both with and without MI, had insufficient frequency of proper medical prescriptions for CVDs (46.6% and 38.9% on average), especially prescription of anticoagulants (19.1% and 21.4%), statins in case of IHD (33.6% and 27.4%) and beta-adrenoblockers in case of CHD (39.4% and 35.6%). During the four-year period of observation, in comparison with post-stroke patients without a history of MI, the mortality rate for all causes was 1.5 times higher (56.6% and 37.6%, p = 0.0001), the incidence of non-fatal MI was higher (2.0% and 0.3%, p = 0.04). CONCLUSION. Patients with a combination of ACVA, AF and MI history are a very high risk group for adverse outcomes observed on an outpatient stage. For these patients it is very important to improve the quality of drug therapy and the effectiveness of secondary prophylaxis.

PURPOSE . To evaluate the effectiveness and safety of warfarin therapy using a clinical laboratory model of centralized monitoring of international normalized relationships, and direct oral anticoagulants in patients with atrial fibrillation in real clinical practice. MATERIAL AND METHODS. In a non-interactive prospective study, 661 atrial fibrillation patients were prescribed oral anticoagulants to prevent cardioembolic complications. The study included patients older than 18 years of age, with creatinine clearance at least 50 ml/min. Рatients were divided into 4 groups: 1 group of 120 people who took warfarin was observed in the conditions of centralized monitoring the international normalized ratio (INR), group 2 – 112 people– was taking Rivaroxaban, group 3 – 106 people– was taking Dabigatran, group 4 – 98 people took Apixaban. Formed 4 groups of patients were comparable in age, concomitant diseases, risks of thromboembolic and hemorrhagic complications.The follow-up period was 2 years from the date of prescribing. RESULTS. In patients who were observed in the clinical laboratory model of centralized monitoring of INR, the TTR was 69.4%. The groups did not differ in the number of thromboembolic complications (p&gt;0.05). Warfarin had an advantage in the amount of large bleeding - 0.9% versus 3.6% taking rivaroxaban and 3.8% taking dabigatran (p = 0.044 and p = 0.035, respectively) without statistical significance for apixaban. CONCLUSION. The ratio of efficacy and safety of warfarin therapy can be successfully maintained at a satisfactory level using a centralized monitoring system of international normalized relationships. It allows you to get comparable treatment results with warfarin and direct inhibitors of blood coagulation factors in real clinical practice.